一名年轻血液透析患者在拔除中心静脉导管 1 年后出现上腔静脉血栓:病例报告

IF 0.1 Q4 EMERGENCY MEDICINE Journal of Emergency Medicine Case Reports Pub Date : 2023-12-08 DOI:10.33706/jemcr.1389895
Osman Beydüz, Abdul Samet Şahi̇n, Ragıp Kadi, Muhammet Fatih Beşer
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摘要

上腔静脉(SVC)综合征是一种罕见但严重的疾病,由上腔静脉或其支流阻塞引起。虽然常与恶性肿瘤相关,但也可因中心静脉置管而发生(1)。导管拔除后的急性SVC综合征并不常见。病例报告:我们提出了一个35岁的血液透析患者的历史中心静脉导管血液透析一年前。在常规血液透析期间,患者出现呼吸短促、颈部肿胀和嘴唇发绀的症状。体格检查显示颈部水肿及明显的浅表血管分叉。在没有影像学检查的情况下,与蜂窝织炎混淆,但后来CT血管造影证实SVC血栓形成。患者开始抗凝治疗后转至三级医院接受进一步治疗。结论:急诊医师应注意SVC综合征,特别是有中心静脉置管史的血液透析患者。虽然它通常与恶性肿瘤相关,但本病例强调了即使在导管拔出后考虑SVC血栓形成的重要性。及时诊断和适当管理对于预防危及生命的并发症至关重要。因此,在鉴别诊断中识别和纳入SVC综合征对于及时干预和改善患者预后至关重要。
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Superior Vena Cava Thrombosis in A Young Hemodialysis Patient After 1 year of Central Venous Catheter Removal: A Case Report
Introduction: Superior vena cava (SVC) syndrome is a rare but serious condition resulting from obstruction of the superior vena cava or its tributaries. Although often associated with malignancy, it can also occur due to central venous catheterization(1). Acute SVC syndrome following catheter removal is uncommon. Case Report: We present a 35-year-old hemodialysis patient with a history of central venous catheterization for hemodialysis one year prior. During a routine hemodialysis session, the patient developed symptoms of shortness of breath, neck swelling, and cyanosis of the lips. Physical examination revealed neck edema and prominent superficial vascular bifurcations. Without imaging studies, it was confused with cellulitis, but CT angiography later confirmed SVC thrombosis. The patient was started on anticoagulation and transferred to a tertiary hospital for further management. Conclusion: Emergency physicians should be aware of SVC syndrome, especially in hemodialysis patients with a history of central venous catheterization. Although it is often associated with malignancy, this case highlights the importance of considering SVC thrombosis even after catheter removal. Prompt diagnosis and appropriate management are essential to prevent life-threatening complications. Therefore, recognition and inclusion of SVC syndrome in the differential diagnosis is essential for timely intervention and improved patient outcomes.
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